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Ann Intern Med 2002 Jul 16;137(2):I54
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PMID: 12118987, UI: 22114226
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Ann Intern Med 2002 Jul 16;137(2):146-7
PMID: 12118982, UI: 22114221
Ann Intern Med 2002 Jul 16;137(2):105-9
Division of General Medicine, University of Texas-Houston Medical School, 6431 Fannin, MSB 1.122, Houston, TX 77030, USA. Philip.C.Johnson@uth.tmc.edu
BACKGROUND: In patients with moderate to severe histoplasmosis associated with AIDS, the preferred treatment has been the deoxycholate formulation of amphotericin B. However, serious side effects are associated with use of amphotericin B. OBJECTIVE: To compare amphotericin B with liposomal amphotericin B for induction therapy of moderate to severe disseminated histoplasmosis in patients with AIDS. DESIGN: Randomized, double-blind, multicenter clinical trial. SETTING: 21 sites of the U.S. National Institute of Allergy and Infectious Diseases Mycoses Study Group. PATIENTS: 81 patients with AIDS and moderate to severe disseminated histoplasmosis. MEASUREMENTS: Clinical success, conversion of baseline blood cultures to negative, and acute toxicities that necessitated discontinuation of treatment. RESULTS: Clinical success was achieved in 14 of 22 patients (64%) treated with amphotericin B compared with 45 of 51 patients (88%) receiving liposomal amphotericin B (difference, 24 percentage points [95% CI, 1 to 52 percentage points]). Culture conversion rates were similar. Three patients treated with amphotericin B and one treated with liposomal amphotericin B died during induction (P = 0.04). Infusion-related side effects were greater with amphotericin B (63%) than with liposomal amphotericin B (25%) (P = 0.002). Nephrotoxicity occurred in 37% of patients treated with amphotericin B and 9% of patients treated with liposomal amphotericin B (P = 0.003). CONCLUSION: Liposomal amphotericin B seems to be a less toxic alternative to amphotericin B and is associated with improved survival.
PMID: 12118965, UI: 22114204
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Ann Pharmacother 2002 Apr;36(4):644-7
Department of Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland. Bernhard.Frey@kispi.unizh.ch
OBJECTIVE: To report a case of transient cholestatic hepatitis occurring in an infant between the third and seventh weeks of life, most likely due to carbamazepine exposure during pregnancy and breast feeding. CASE SUMMARY: A boy, born to an epileptic mother who had been treated with carbamazepine monotherapy throughout pregnancy and breast feeding, experienced asphyxia at birth with transient hepatic dysfunction in the first week of life. After full recovery from asphyxia, he experienced a second period of liver dysfunction, presenting as cholestatic hepatitis that lasted approximately 5 weeks. Infectious and metabolic etiologies as well as extrahepatic biliary atresia were excluded. DISCUSSION: Carbamazepine is known to induce hepatic damage in children and adults. As the drug crosses the placenta and is excreted into breast milk, infants of mothers taking carbamazepine might also develop liver dysfunction. In addition to the present case, there are 2 well-documented case reports of cholestasis in association with transplacental and transmammary carbamazepine exposure. CONCLUSIONS: Carbamazepine-induced hepatitis may occur in association with prenatal exposure and breast feeding. This may expose infants to unnecessary diagnostic procedures, and should therefore be mentioned in the company's product information.
PMID: 11918515, UI: 21916349
Ann Pharmacother 2002 Apr;36(4):641-3
Department of Internal Medicine, Hospital Marques de Valdecilla, Santander, Spain. joselhh@teleline.es
OBJECTIVE: To document a case of serotonin syndrome (SS) associated with mirtazapine monotherapy, review the previously reported cases of SS associated with this tetracyclic antidepressant, and discuss the possible pathogenic mechanisms leading to this serious adverse drug reaction. CASE SUMMARY: A 75-year-old man developed agitation, confusion, incoordination, and gait disturbance because of progressive rigidity. Mirtazapine had been started 8 days earlier to control major depression. Physical examination revealed diaphoresis, low-grade fever, hypertension, tachycardia, bilateral cogwheel rigidity, hyperreflexia, tremor, and myoclonus, symptoms and signs that are consistent with severe SS. DISCUSSION: A review of the cases of SS with implication of mirtazapine as the cause was performed. The possible pathogenic mechanisms leading to this adverse reaction in this patient are also discussed, and pathophysiologic hypotheses are formulated. CONCLUSIONS: Although mirtazapine offers clinicians a combination of strong efficacy and good safety, we suggest bearing SS in mind when prescribing this drug, especially in frail, elderly patients with underlying chronic conditions. In these patients, it might be more adequate to start mirtazapine therapy at a lower dose (<15 mg/d).
PMID: 11918514, UI: 21916348
Ann Pharmacother 2002 Apr;36(4):631-3
Department of Pharmaceutical Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. caroline_warnock@camh.net
OBJECTIVE: To report a case of possible cross-sensitivity between selective serotonin-reuptake inhibitors (SSRIs). CASE SUMMARY: A 20-year-old Southeast Asian man developed a maculopapular rash soon after starting paroxetine. Following resolution of this rash, another skin reaction with the same distribution and appearance occurred after sertraline therapy was started. DISCUSSION: Cross-reactivity between drugs with similar structures has been reported; however, cross-reactivity among SSRI antidepressants is unexpected given their differences in chemical structure. CONCLUSIONS: The possibility of cross-reactivity between SSRI antidepressants should be considered by clinicians who wish to switch from one SSRI to another due to a dermatologic reaction.
PMID: 11918512, UI: 21916346
J Clin Psychiatry 2002 Jun;63(6):524-7
Fukui Prefectural Hospital, Center of Psychiatry and Neurology, Japan. shigehiro@p2422.nsk.ne.jp
BACKGROUND: Neuroleptic-induced akathisia can be severely distressing to some patients. and rapid treatment would be preferable. However, there have been relatively few studies conducted regarding the rapid treatment of akathisia. The effect of intravenous diazepam at the beginning of treatment for akathisia was studied in an open clinical trial. METHOD: The subjects were 18 patients with schizophrenia or bipolar I disorder (DSM-IV criteria) who developed neuroleptic-induced acute akathisia during antipsychotic medication and who required immediate relief from the distress of akathisia. Diazepam was given intravenously to the patients at a rate of 5 mg per 30 seconds. RESULTS: All 18 subjects experienced immediate relief from akathisia after the injection of diazepam (mean +/- SD dose = 12.6 +/- 2.6 mg; range, 10-17 mg). They reported no serious adverse effects. CONCLUSION: The results suggest that intravenous diazepam could be used in the treatment of patients with severely distressing akathisia who require immediate relief.
PMID: 12088165, UI: 22082696
J Clin Psychiatry 2002 Jun;63(6):513-5
Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI, USA. Hubert_Fernandez@mhri.org
BACKGROUND: Most clinicians perceive psychosis in dementia with Lewy bodies (DLB) as more difficult to treat than Parkinson's disease, yet there are no reports comparing the antipsychotic response between the 2 disorders. METHOD: All charts of Parkinson's disease and DLB patients at our Movement Disorders Center, Memorial Hospital of Rhode Island, Pawtucket, given quetiapine for psychosis were reviewed. Demographic data, including type and severity of psychosis, before and after Unified Parkinson's Disease Rating Scale (UPDRS)-motor scores, motor worsening, and treatment response (recorded as poor/none, partial, or total), were obtained. The chi-square test was used to assess differences in efficacy and tolerability of quetiapine between Parkinson's disease and DLB patients. RESULTS: Eighty-seven Parkinson's disease and 11 DLB patients with psychosis were analyzed. No significant difference in mean age, levodopa dose, quetiapine dose, duration of quetiapine use, or baseline UPDRS-motor score was noted between Parkinson's disease and DLB patients. Eighty percent (70/87) of Parkinson's disease patients and 90% (10/11) of DLB patients had partial to complete resolution of psychosis using quetiapine (p = .40). Motor worsening was noted at one point in 32% (28/87) of Parkinson's disease and 27% (3/11) of DLB patients over the duration of quetiapine use (p = .74). CONCLUSION: Long-term quetiapine use was generally well tolerated in this geriatric Parkinson's disease and DLB population. Mild motor worsening occurred in some patients. No significant difference in long-term efficacy and motor worsening associated with quetiapine treatment was noted between the 2 disorders.
PMID: 12088163, UI: 22082694
MMWR Morb Mortal Wkly Rep 2002 Jun 28;51(25):548-9
On December 7, 2001, the Sawyer County Department of Health and Human Services in northwestern Wisconsin notified the Wisconsin Division of Public Health about five cases of Campylobacter jejuni enteritis. All of the ill persons drank unpasteurized milk obtained at a local dairy farm. This report summarizes the investigation of these and other cases and of a cow-leasing program used to circumvent regulations prohibiting the sale of unpasteurized milk in Wisconsin. The outbreak highlights the hazards of consuming unpasteurized milk and milk products.
PMID: 12118535, UI: 22113648
MMWR Morb Mortal Wkly Rep 2002 Jun 28;51(25):545-8
During January-April 2002, Salmonella serotype Newport was isolated from 47 persons in five states: New York (34 cases), Michigan (five), Pennsylvania (four), Ohio (two), and Connecticut (two). Antimicrobial-susceptibility testing of three isolates by CDC revealed resistance to amoxicillin/clavulanate, ampicillin, cefoxitin, ceftiofur, cephalothin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline. In addition, two of three isolates were resistant to kanamycin; two had decreased susceptibility or resistance to ceftriaxone. To determine the cause of the outbreak, the New York State Department of Health (NYSDOH) and CDC conducted a case-control study. This report summarizes the results of this investigation, which implicated exposure to raw or undercooked ground beef as the vehicle of transmission. The findings also highlight the emergence of multidrug-resistant S. Newport in the United States. These strains exhibit decreased susceptibility or resistance to ceftriaxone, thereby complicating empiric therapy for serious Salmonella infections. Clinicians should be informed of the emergence of these S. Newport strains, and persons should refrain from eating undercooked ground beef and wash their hands after handling raw ground beef.
PMID: 12118534, UI: 22113647
N Engl J Med 2002 Jul 18;347(3):216-8; discussion 216-8
PMID: 12125711, UI: 22120707
PMID: 12125710, UI: 22120706